Implementation of a Robotic Gynecologic Surgery Program in a Rural Setting: Impact on Presence of Assistant Surgeon and Route of Hysterectomy.

Abstract

Background and objectives: Robotic surgical technology may obviate the need for an assistant surgeon when performing hysterectomy. In rural communities where physician shortages remain a major barrier to healthcare access, reducing the number of surgeons necessary to complete a hysterectomy would be of significant consequence. We sought to investigate the impact of robotic surgery on both the presence of an assistant surgeon and route of hysterectomy following implementation of a robotic surgery program at a single-site community hospital.

Methods: Retrospective chart review of hysterectomies performed before and after implementation of a robotic surgical program. Hysterectomies were classified by presence of an assistant surgeon, and by mode of hysterectomy (abdominal, laparoscopic, robotic, and vaginal). We observed the distribution of outcomes between the two study periods and compared them with the χ² test.

Results: Following implementation of a robotic surgical program we observed a statistically significant decrease in the presence of an assistant surgeon at the time of hysterectomy from 86.7% to 29.7%, p ≤ 0.0001. There was also an increase in the percentage of hysterectomies performed by minimally invasive technique from 67.0% to 87.4%, p ≤ 0.0001.

Conclusion: Following implementation of a robotic gynecologic surgery program at a single-site rural community hospital, we observed a reduction in the utilization of an assistant surgeon at time of hysterectomy. Additionally, we observed a significant increase in the rate of minimally invasive hysterectomies performed.